Assessment of an updated double‐vasopressor automated system using Nexfin ™ for the maintenance of haemodynamic stability to improve peri‐operative outcome during spinal anaesthesia for caesarean section

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Abstract
Summary: Hypotension occurs commonly during spinal anaesthesia for caesarean section, associated with maternal and fetal adverse effects. We developed a double‐vasopressor automated system with a two‐step algorithm and continuous non‐invasive haemodynamic monitoring using the Nexfin ™ device. The system delivered 25 μg phenylephrine every 30 s when systolic blood pressure was between 90% and 100% of baseline, or 2 mg ephedrine at this blood pressure range and heart rate < 60 beats.min −1 ; and 50 μg phenylephrine or 4 mg ephedrine when systolic blood pressure was < 90% of baseline with the same heart rate criterion. Fifty‐seven women received standardised spinal anaesthesia. Twenty‐seven (47.4%) had at least one reading of hypotension defined as systolic blood pressure < 80% baseline. Systolic blood pressure was within 20% of the baseline in a mean ( SD ) of 79.8 (20.9)% of measurements. Fifty‐three (93.0%) women required phenylephrine before delivery while 10 (17.5%) required ephedrine. Six women (10.5%) experienced nausea and three (5.3%) vomited. The system was able to achieve a low incidence of maternal hypotension with good maternal and fetal outcomes.
Funding Information
  • SingHealth Foundation Grant (SHF/CTG047/2012)

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